Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Methods: 198 patients with perforated duodenal or prepyloric ulcer that were surgically treated from 2003 to 2014 were included in this study. 140 were operated within 2-6 hours from the onset of symptoms, 55 within 6-24 hours, and 3 patients after 24 hours. Results: Laparoscopic simple closure with Graham patch was performed in 179 patients. In 19 patients with known chronic ulcer resistant to pharmacologic therapy, who were operated within 6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken. Conversion to open repair was necessitated in four patients. The operating time was 40-100 min for the Graham patch repair and 120-155 min for the Taylor procedure. During follow-up, 48% of patients from the "Graham patch" group and no one from the "definitive procedure" group had recurrent ulcer. Conclusions: Laparoscopic treatment of perforated peptic ulcer is technically feasible and safe when performed by experienced surgeons. In certain cases more definitive procedures may achieve better long-term results.

Results. Performing the organ-sparing operations doesn't increase the risk of intraoperative complications. In all patients with hormone-active tumors we found decline of pathologically increased hormone levels and trend to regress of clinical manifestations of the disease in early postoperative period. We found no difference in local recurrences in both groups, and its occurrence did not exceed 3.33%. Refractory postoperative adrenal insufficiency was observed only in corticosteroma patients in spite of surgery volume. In case of both side adrenal tumors there was no need in replacement therapy after total adrenalectomy from there one side and resection from the other. Conclusions. In cases of adrenal tumor performing organ-sparing operations is advisable, if there are no preoperative sings of malignancy.

Currently, a unified approach to the treatment of peptic ulcer of the upper gastrointestinal tract has been developed, based on knowledge of the pathogenesis of the disease. However, standard methods of conservative and surgical treatment do not bring positive results to a number of patients. The reason may lie in the impossibility of establishing the true etiological factor of this pathology. It must be remembered that patients with of the gastroduodenal zone are not a homogeneous group and require a differentiated approach to diagnosis and treatment. The article describes a clinical case of successful of complicated ulcerative lesions of the gastric and duodenal mucosa, resistant to various methods of conservative and surgical treatment.

ЦЕЛЬ. Оценить возможность применения лазерных технологий при лечении перианальной болезни Крона. МЕТОДЫ И МАТЕРИАЛЫ. В исследование включены 18 пациентов с перианальной болезнью Крона, которые проходили лечение в хирургическом отделении ¹ 3 ПСПбГМУ им. И. П. Павлова. Исследование проводили в два этапа. Первый этап заключался в постановке дренирующего сетона (лигатуры) в основной свищевой канал. Второй этап выполнялся через 3 месяца. Проводили удаление сетона с дальнейшей лазерной деструкцией свищевого хода. На фоне хирургического лечения больные получали консервативную терапию согласно рекомендациями гастроэнтерологов. РЕЗУЛЬТАТЫ. Каждый этап хирургического лечения длился не более 30 мин, под внутривенной анестезией. Интраоперационная кровопотеря не превышала 5 мл. Койко-день каждого этапа, ввиду отсутствия осложнений, варьировал от 0 до 2 суток. Через 3 месяца после двух этапов хирургического лечения обследование показало полное закрытие свищевых ходов. Максимальный срок наблюдения безрецидивного течения -24 месяца. Все пациенты получали противовоспалительную терапию, 63 % больных продолжали получать генно-инженерную биологическую терапию. ЗАКЛЮЧЕНИЕ. При перианальной болезни Крона эффективны сфинктеросохраняющие методики. Это улучшает качество жизни и снижает риск инвалидизации пациентов.